Background
Acetabular fractures are serious and challenging orthopedic injuries. Many of these fractures
may potentially result in late complications that can occur with or without initial surgical
treatment. Such complications usually end in post-traumatic arthritis. Once symptomatic
post-traumatic arthritis has developed, options for salvage are generally limited to total hip
arthroplasty (THA) and arthrodesis. Whether initial nonoperative or operative treatment was
used to manage acute and highly displaced acetabular fractures, formidable problems such
as nonunion, malunion, bone defect, and heterotopic bone may complicate the arthroplasty.
More recent studies have evaluated the techniques of THA after an acetabular fracture initially
managed by a nonoperative or an operative course. Various reconstructive strategies have
been assessed in an attempt to advice improvements in the surgical protocol.
Aim
The aim of the work was to evaluate the early results of THA using cementless acetabular
components combined with bone grafting in the reconstruction of the hip joint in patients
with post-traumatic arthritis after an old nonoperatively treated acetabular fracture or fracture
dislocation.
Patients and methods
This prospective study included 12 patients who had end-stage arthritis. All patients had old
acetabular fractures either with or without hip dislocation. All patients had a nonoperative
treatment for their fractures 1–5 years before presentation for total hip replacement. Clinical,
laboratory, and radiological evaluations before surgery were performed. In all patients,
conventional cementless cups combined with bone graft from their own femoral heads were
used to fill defects and reconstruct the acetabulum. The duration of the follow-up period ranged
from 1 to 3 years.
Results
Clinically, there was marked improvement in the Harris Hip Score (satisfactory results in 83.33%
of the study group at the last follow-up) with special concern to postoperative pain relief, the
range of hip movement, and the walking distance. Radiologically, all cups were placed in the
normal hip center with no early signs of cup loosening, migration, or position change with good
integration of the bone graft.
Conclusion
The results were very satisfactory and significantly in favor of using this technique using
conventional cementless cups combined with autogenous bone grafting to reconstruct the
acetabulum in certain cases of old united fractures of the acetabulum saving the extra costs
of metallic augments, special cups, or modular reconstructions using cages or rings and
achieving a superior biological and biomechanical reconstruction. |
